Written by Julie Higginbotham, Senior Case Coordinator, Mecklenburg County CDSA
In early intervention, everything we do has to be tied to a family’s ability to function more successfully in their daily routines and activity settings. Sure, families come to us because some specific concern for their child – maybe this little guy was referred because his pediatrician felt that he wasn’t talking enough at his 2-year well baby visit, and possibly that little girl was born earlier than we would like. But once we know they’re eligible and we learn more about their families, everything switches gears. We move from a potential skill deficit or established condition and look more at how those initial concerns are impacting the rest of their day. The Individualized Family Service Plan, or IFSP, is the document that drives teams in the right direction because it maps out families’ priorities and concerns, the child’s functioning within their daily routines, the outcomes that describe the specific routines for us to support, and the services that are helping the family achieve those outcomes. It all has to make sense, though – a family’s IFSP should show appropriate services to support the outcomes that have been written, based on the child’s skills within the daily routines that the family has identified as a priority or concern. See how that works? Kinda sounds like “The House That Jack Built.” You know, this is the IFSP that Jack’s team built. These are the priorities that go in the IFSP that Jack’s team built. But, I digress…..
The IFSP is a document that is constantly evolving – makes sense, children and their families are constantly changing, too. While we are always assessing how things are progressing on an ongoing basis (visit to visit), there are some times when a formal assessment might be needed to get more information about a specific need. You see, once you have an IFSP in place, any specific assessments (like a physical therapy assessment) go onto the plan as a formal service. When you hone in on the concerns that lead to outcomes and services, sometimes you might wonder which one comes first – the outcomes or the assessments? Here are a few ways that might happen.
- Susie is a bright little girl who was referred to the Infant-Toddler Program because she was born at 26 weeks gestation and was automatically eligible. She has had a nutritionist on her team to help make sure that she’s gaining weight and getting everything she needs to grow and learn. Now that she is 13 months old, she has figured out that she would much rather scoot on her bottom to get to her toys, rather than turn over and crawl to get across the room. The family isn’t worried about it at home, even if you might be, but they have noticed that Susie is having trouble at the play area at the mall because she can’t play on the equipment by herself. Her parents have to go over every time she wants to go down her favorite little slide because she can’t climb up the stairs. There’s a great activity for the family, and it makes sense to write an outcome and have a discussion as a team to add a physical therapy assessment to get more information about how to support this child and family in this activity setting.
- Sam is an active 2-year-old with a great sense of humor. He was determined to be eligible a few months ago because he wasn’t quite talking as much as he should be for his age, and the family has a speech therapist coming in to show them ways to use his words when he gets frustrated as he tries to tell his mother that he wants to go outside to play. Sam’s parents have noticed that, after Sam has roughhoused outside with his brother, he seems to be having some trouble getting himself calmed back down. They are a little concerned that it takes him a while to move on to the next part of their day. They think it might just be because he’s a boy and he’s 2 years old, but they want to know if there are ways to help get him more settled and see if there’s something else going on. The team has a discussion to see who has some expertise to bring to the table, and the IFSP team decides that an occupational therapy assessment is a good way to get more information before making decisions on a formal outcome and strategies.
Hmmm. Looks to me like both scenarios make sense – in the first one, there’s a concern that the family wants to go ahead and address in an outcome, but in the second, there’s a concern that has landed on the family’s radar, but it isn’t quite a priority for an outcome just yet. This would be Reason #768 that it’s called the Individualized Family Service Plan – each family is going to go through the process in a different way. While there are some specific rules for IFSPs, there are other parts that have a little more wiggle room depending on the family’s needs, and this would be one of them. There are a few things to keep in mind, though….
- Everything has to stay within a family’s routines and activity setting in the home and community. When a family has a concern, we have to address it within the context of a routine. We don’t do assessments or add services because a child isn’t hitting a certain milestone, we do it because that milestone is important to the success of a specific family routine or activity.
- The team has to look at how each person can address the family’s concerns and priorities. Perhaps Sam’s speech therapist has had some great ideas about ways to talk to him to help him get more settled after playing with his brother, but we need some more information to get him focused enough to hear it. Maybe the nutritionist figured out that Susie’s reflux is making her uncomfortable, keeping her from wanting to be on her belly to learn to crawl. The team may or may not already have the expertise needed to address new concerns that come up.
- Adding an assessment doesn’t have to mean adding a service. We have to be careful about how we talk about assessments. We don’t do them to see if a child “qualifies” for a service, we do them to help the IFSP team make decisions about the best way to support the child and family. The assessment could shed some light on how the child learns so we can make an adjustment to how we are engaging with the child, or it could help us figure out what we might need to do to get a new support in place for the family.
So as “The IFSP that Jack’s Team Built” evolves and changes with Jack and his family, you’ll see that there is more than one way to address concerns and priorities as they come up. What have you noticed as you’re working with families and building IFSPs with teams? How have you addressed new concerns and priorities? Leave us a comment – you never know, you might just give someone else a great idea to take into their next visit or IFSP review with a family!